Henry Mphwanthe: Strengthening the Self-Reliance of Malawi's Health Sector, One Building Block at a Time
“…for me, there was just a very close link between my everyday life and the problems I saw in healthcare.”
Henry's profile was originally published on Medium.
When Henry Mphwanthe arrived at the University of Sussex at the age of 20, he didn't know his future lay in health economics. He had travelled from Malawi to the UK to begin graduate work, studying a range of development issues. It was only later in his course work that his interest in health emerged.
Henry explained, "I've had so many family members affected by healthcare issues. I've had family members who have died of AIDS and perhaps they could have survived if they had gotten the right care at the right time. But, 18 years ago, there weren't enough drugs, they were very expensive, and that is a health systems challenge. When you're living in a country like Malawi and you visit a friend in hospital and you see how devastating the situation is, for me, there was just a very close link between my everyday life and the problems I saw in healthcare."
For the next several years, Henry studied health economics and public policy, earning master's degrees from the University of Sussex and later, Oxford. Afterward, he spent two years working with Nigeria's Ministry of Health, before returning home to Malawi. Now, Henry is part of a specialized cadre of Health Policy Plus (HP+) economists who are seconded to ministries of health to provide hands-on technical assistance and capacity development for health policy and health financing reform. As a health economist, Henry is advising Malawi's Minister of Health, helping to advance a multi-pronged approach to strengthening Malawi's health sector and finding innovative ways to finance it.
Reviving a Key Decision-Making Body
As part of his work, Henry has been supporting the ministry to coordinate and institutionalize a Health Financing Technical Working Group—a key decision-making body within the Ministry of Health, charged with coordinating its healthcare financing activities. After years of inactivity, the group now meets quarterly and has successfully commissioned and endorsed several pieces of work, including the development of a performance-based financing framework, an essential healthcare package, and a health financing strategy. The group is also responsible for making health financing policy reform recommendations and provides regular updates to the Ministry of Health's senior management on the implementation of health financing reforms.
Advancing a Health Financing Strategy and Systems Assessment
Originally developed in 2014, the Ministry of Health chose not to adopt or implement the then healthcare financing strategy, citing a lack of engagement by key stakeholders and insufficient evidence on the feasibility of the proposed strategy. Now, as Malawi faces insufficient resources to fully implement its newly developed health sector strategic plan, the health financing strategy's progress is back at the top of the ministry's agenda. HP+ is leading the redevelopment of the strategy and working alongside the ministry to generate evidence on the strategy's feasibility by conducting a health financing systems assessment. The assessment—to be released later this year—will further inform the country's health financing strategy and pave the way for building an efficient health financing system to better sustain Malawi's historically donor-dependent health sector.
Building an Investment Case
One building block crucial to the health financing system is the Global Financing Facility—a multi-donor trust fund, managed and monetarily matched by the World Bank. In November 2017, Malawi qualified as a Global Financing Facility recipient and, since then, Henry and ministry colleagues have been working with civil society and private sector stakeholders to develop an investment case in the hopes of increasing Malawi's health sector resources.
“The goal is that Malawians don’t suffer from any financial hardships from accessing [health]care.”
Another building block toward health financing self-reliance is the introduction of pay-for-service fees. The Ministry of Health, with HP+ support, is beginning to implement pay-for-service reforms at the central and district levels, working hard to ensure that the introduction of these reforms maintain equity in both the quality and accessibility of health services. Under the pay-for-service scheme, revenue collected from patients who can pay is reinvested back into the hospital to improve healthcare delivery.
Henry explains, "If I get sick, the best place in Malawi for me to go is the government hospital. But who is losing and who is winning? The government is losing, and the insurance company is winning because [even though I have insurance], I go to a hospital where services are free. So, perhaps we can tap into this group that can pay for services, take that money, and reinvest it back into the hospital."
A key part of this work has been supporting hospitals to develop business plans for paid services and to establish a committee to manage the revenue generated in an accountable and transparent way. At the minister's request, Henry and HP+ colleagues also assessed the feasibility of establishing paid services in district hospitals. Since then, they've presented recommendations to the minister on how to establish paid services in the districts, how hospitals could use the revenue they collect, and how to best provide care to paying users without compromising quality for non-paying users.
Reflecting on his work with the ministry and the progress they've made so far, Henry explains, "The goal is that Malawians don't suffer from any financial hardships from accessing [health]care. If they can contribute, they should. If they can't, they should still be able to access care without thinking twice about it."
As for those early days in Sussex, when Henry's path led him to health economics, he shares, "I could have been an engineer, but I'm so glad I'm doing more interesting work."